Sudden Cardiac Arrest in Hemodialysis Patients with Wearable Cardioverter Defibrillator

Abstract

BackgroundThe survival outcome following a sudden cardiac arrest (SCA) in hemodialysis (HD) patients is poor regardless of whether an event takes place in or out of a dialysis center. The characteristics of SCA and post-SCA survival with HD patients using a wearable cardioverter defibrillator (WCD) are unknown.MethodsAll HD patients who were prescribed a WCD between 2004 and 2011 and experienced at least one SCA event were included in this study. Demographics, clinical background, characteristics of SCA events were identified from the manufacturer's database. An SCA event was defined as all sustained ventricular tachycardia/fibrillation (VT/VF) or asystole occurring within 24 hours of the index arrhythmia episode. The social security death index was used to determine mortality after WCD use.ResultsA total of 75 HD patients (mean age = 62.9 ± 11.7 years, female = 37.3%) experienced 84 SCA events (119 arrhythmia episodes) while wearing the WCD. Sixty six (78.6%) SCA events were due to VT/VF and 18 (21.4%) were due to asystole. Most SCA episodes occurred between 09:00 and 10:00 (RR = 2.82, 95% CI [1.05, 7.62], P < 0.0001), followed by the 13:00–14:00 time interval (RR = 2.22, 95% CI [0.79, 6.21], P = 0.006). Acute 24-hour survival was 70.7% for all SCA events; 30-day and 1-year survival were 50.7% and 31.4%, respectively. Women had a better post-SCA survival than men (HR = 2.41, 95% CI [1.09, 5.36], P = 0.03).ConclusionsThe use of WCD in HD patients was associated with improved post-SCA survival when compared to historical data.

Prognostic Value of Serial Changes in High-Sensitivity Cardiac Troponin I and T over 3 Months Using Reference Change Values in Hemodialysis Patients

“…There is a need for risk-stratification strategies for SCD in HD patients. In the USRDS database, the single largest cause of cardiac death in HD patients is attributed to arrhythmia mechanisms (64% of all cardiac deaths or 27% of all-cause mortality) (2)(3)(4)(5). Furthermore, in the HEMO (Hemodialysis) and 4D (Deutsche Diabetes Dialyse Studie) trials, 22% and 26% of deaths, respectively, were sudden (20,21 ).…”

“…Based on data from the US Renal Data Base System (USRDS), all-cause adjusted mortality for patients receiving HD was 174 per 1000 patient-years in 2012 (2 ). Among these, the single largest cause of cardiac death in HD patients is related to an arrhythmic mechanism, with sudden cardiac death (SCD) being responsible for more than one-fourth of all-cause mortality and linked to 64% of all cardiac deaths (3,4 ). Consequently, there is a need for novel preventive and risk-stratification strategies for SCD in HD patients (5 ).…”

Arrhythmia and Sudden Death in Hemodialysis Patients

“…One paper detailed 84 sudden cardiac arrest events in dialysis patients with wearable cardioverterdefibrillators (14). In this selected cohort, 78% of initial rhythms were ventricular tachycardia (VT; 64.3%) or ventricular fibrillation (VF; 14.3%), and 21.4% were asystole (i.e., not shockable).…”

Influence of hemodialysis duration on mid-term clinical outcomes in hemodialysis patients with coronary artery disease after drug-eluting stent implantation

“…Although little is known how HD duration influences these mechanisms, we surmise that these mechanisms are more enhanced as the HD duration increased. Specific treatments to prevent SCD, including β-blocker therapy, statin therapy, erythropoietin therapy, and wearable cardioverter defibrillator, have shown their usefulness in HD patients [29][30][31][32]. In addition, the usefulness of oral nicorandil to reduce cardiac death in hemodialysis patients has been well investigated [33,34].…”